a) Publish online – It doesn’t have to be in a journal but could also simply be on your own website. It lets patients know how you think about different treatments. Patients would love to read case studies about other patients you might’ve seen. Several patients conduct at least basic online search before visiting a doctor or an ambulatory surgery center. What does your web presence (not just your website) reveal about you?

b) Bring a certain focus to your Center – e.g. a specialty differentiation. To attract higher quality patients, it’ll be good to focus on a specific area within your specialty. One ambulatory surgery center focuses on the highest volume of lower gastroenterology cases it does. Another focuses on EUS/ ERCP procedures. Yet another focuses on removing large polyps. It becomes easier to be known for 1 or 2 key things than be all things for all people.

c) Share your medical records with your patients just as you would with referring doctors – What if we trusted our patients more with medical information? Patients will appreciate what you did for them if they receive and see their own medical records. It also encourages 2-way communication.

d) Monitor health of patients using vitals that are out of range (e.g. very high BMI) and have your office give them a call to check on them. This reverses the scheduling process. You can also track when patients turn 50 and invite them for a colonoscopy (if you are GI-based center).

e) Use technology to standout. Encourage or give away remote monitoring equipment (e.g. to measure insulin, asthma, BP and so on) to select patients, capture their data regularly into their medical record and communicate proactively with them. Technology-enable your center from check-in to check-out and make the flow easy. They will talk to their families and friends about this.

All the above suggestions would make the ambulatory surgery center or medical practice standout amongst its patients – referrals usually follow.

A more interesting question however is to ask yourself if you simply want to increase patient volume for its own sake or increase it in a way that would increase reimbursements but not dramatically increase costs/ time spent. More on that topic in another post.

Before considering this question, let’s recap the process before it’s time to send patients a financial statement for the amount that is her responsibility. A patient is responsible for a service usually when her insurance pays nothing or a portion of the fees. Before a visit or a procedure, it’s imperative to check a patient’s eligibility and benefits. We find several practices/ surgery centers that do not have the bandwidth to complete this task and the practice management system is not equipped to complete this task automatically.

If that’s the case with your organization, sign up with independent eligibility verification services – remember that it’s never fully automated. Checking a patient’s eligibility decreases the risk of the claim being denied by insurance. After the service is performed, it’s important to submit charges within 24 hours of service – the longer it takes to submit charges, the greater likelihood that it may be denied. After receiving payments, it’s important to post payments in the practice management system immediately. It’s at this point when we know what a patient is responsible for.

The answer to the question above (should you be send statements daily or in bulk?) is simple: send them daily. At the outset, collecting money from patients after a service is one of the most difficult parts of the revenue cycle. It gets a lot more difficult to collect with every passing day from the date of service. Often practices make the mistake of sorting patients alphabetically and submitting statements in that order. This process does not take into account the amount in question or even the likelihood of getting paid from that patient. Ideally, a practice or its billing company must use analytics to determine the likelihood of getting paid and send statements accordingly. If a patient has gone through an endoscopy under a failed insurance plan then the patient must be made to pay the very day of service. Consider if a patient is a repeat offender or if she has occasionally lapsed. What type of insurance plan history does the patient have. While it’s the responsibility of the center to bill all patients, it’s also important to remember that not everyone will respond or even pay the same way. If she is routinely missed payments or ignored them, bill immediately. The administrator or system must determine this as soon as a patient is provided service – this decision must extend through the process and trigger a statement and type of statement once payments are posted.

In summary, it’s important to think about the process around patient accounts receivable differently and not treat all claims and all plans equally after a point. It’s also important to work on statements daily and send them. On a future blog post, I’ll explain methods of sending statements and what must happen after a statement is submitted – when and whom should you be calling?

A claim can be denied even before a patient is seen by the physician. Essentially, the revenue cycle begins when a patient calls in to schedule an appointment. As simple as it may sound, the primary cause of most pre-visit denials is the lack of a checklist. What we don’t find in centers after centers, is the execution of the following list before every patient visit:

1. Is the patient eligible?
2. Has the insurance authorized for this procedure?
3. How much co-pay is due for this visit?
4. How much in deductibles will this patient have to pay?
5. Is there a past balance?

Checking off each activity off the list can significantly help reduce denials. Common excuses for practices to detour the process are “We do not have to do it for all the patients” or “We have a huge patient volume, this is impossible”. Due to the lack of this pre-visit process, surgery centers and practices have suffered in terms of growing denials and backlog in patient receivables.

The process can look more or less like this – say, a patient calls in for an appointment; the front desk can schedule the appointment considering physician’s schedule and vacant slots. Get eligibility for scheduled the patient done at least 2 days in advance and authorizations at least 5 days prior to the date of service. Hence, less confusion at the time of service. This can be done online or by single phone call to the carriers. Front desk can inform the patient about past liabilities at the time of appointment scheduling and collect the balance upfront. This helps to contain patient receivables.

Implementation is vital as it makes way for a more efficient practice. It is less hassle for the practice to chase down denials and receivables and for patients who have to pay up for non-covered or non- authorized procedures.

Patient collection is an integral part of the revenue cycle management, yet it is also the task medical practices enjoy the least. Patient deductibles are in general increasing. According to a study, 22.7 percent of people under the age of 65 with private health insurance are enrolled in high deductible health plans. According to the McKinsey report, 36 percent of patients have a balance of 60 days or more past due. So bad debts are on a rise as well. Determining the actual amount of money due and finding effective, yet cheaper ways to recover it is what becomes tricky.

Recommendations on improving patient collections:

Determine how much money is yet to be recovered and sitting on the accounts.
To draw an action plan you must first know how much is it that you are actually looking at. Do individual outstanding patient responsibility analysis. This will help you come to a specific dollar amount which will help you determine the amount of effort that needs to be put in this domain.

Filter accounts.
After short listing your patient accounts try and look for patterns by which money can be recovered easily (e.g: patients recently seen can be more likely to pay).

Take a call.
Determine whether you are willing to write off certain accounts v/s pursue aggressively by constant follow ups and reminders. Resorting to collection agencies can also be a part if your plan but the feasibility should be thoroughly calculated.

Give options.
Design payment plans for patients with higher balances; this would help in reducing the burden of one time full payment on your patients, keeps the money coming in at intervals and most importantly your patients will be happy. Provide online payment options – many if not most, of the patients are accustomed to carrying their transactions online.